A New Name for a Common Condition, what is MASLD?


Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), previously known as nonalcoholic fatty liver disease (NAFLD), is becoming increasingly recognized as a major health issue for women, especially around the time of menopause. This new term also helps reduce stigma and encourages a whole-body approach to diagnosis and care, focusing on metabolic health rather than alcohol consumption history.


"Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease influenced by genetic, lifestyle, and environmental factors. While MASLD is more prevalent in men, women are at increased risk after menopause, highlighting the critical pathogenetic role of sex hormones. The complex interplay between estrogen deficiency, visceral fat accumulation, metabolic syndrome (MetS), and inflammation accelerates disease progression, increases cardiovascular (CV) risk, and triggers a cycle of worsening adiposity, metabolic dysfunction, and psychological problems." (Milani, et al, 2025)



What Causes MASLD?


MASLD occurs when excess fat builds up in liver cells, usually due to metabolic imbalances. Key risk factors include:


  • Being overweight or obesity
  • Type 2 diabetes, prediabetes or insulin resistance
  • High blood pressure (hypertension)
  • Abnormal cholesterol/ApoB or triglyceride levels
  • Menopause 


Interestingly, MASLD can also affect people with normal body weight (sometimes called “lean MASLD”), especially those with poor diet quality, hormonal changes, or genetic predisposition.


Why It Matters?

MASLD is more than just a liver condition. It’s a metabolic disorder that increases the risk of:


  • Heart disease (the leading cause of death in MASLD patients)
  • Kidney disease
  • Loss of muscle mass (sarcopenia)
  • Progression to metabolic dysfunction-associated steatohepatitis (MASH), fibrosis, cirrhosis, or even liver cancer

The Connection Between Menopause and MASLD

Estrogen’s Protective Role

Estrogen helps protect the liver by improving how the body metabolizes fat and glucose. During menopause, falling estrogen levels lead to an increased risk of visceral fat, weight gain, insulin resistance, and changes in cholesterol and triglyceride levels. These changes create a “perfect storm” for the development and progression of MASLD.​


"There is an interplay of hormonal issues and aging that create a unique path for development of liver disease in menopausal women. The impact of an understanding of how menopause mediates liver disease is important as there are growing numbers of menopausal women worldwide." (Brady, 2015)

Rising Risks of MASLD After Menopause


Studies show that postmenopausal women are more likely to develop fatty liver and experience faster progression of liver fibrosis compared to premenopausal women or men of the same age. The average age of menopause in North America is 52 years of age. Women who enter menopause earlier (before age 45), are at even greater risk for MASLD and associated conditions like high blood pressure (hypertension) and diabetes.​


The Role of Hormone Replacement Therapy (HRT)


Early studies and evidence suggests that HRT may slow liver fibrosis progression in women with MASLD, although its broader safety and long-term impact on liver outcomes are still under investigation.​ However, always speak to your primary health care provider to discuss the benefits and risks for your individual needs and for symptomatic women who suffer from conditions such as vasomotor symptoms or want to prevent bone loss, and are within the 10 year window of their final menstrual period, HRT may be a treatment for them.

Screening of MASLD Matters in Women


Women in midlife should be assessed for risk factors like central obesity, metabolic syndrome, and family history of liver disease.​ Because MASLD is often silent in its early stages, regular checkups and blood tests are vital for those with risk factors.


Primary care providers need to consider how menopause, hormones, and individual metabolic health interact to guide screening and early interventions for liver health.​ Prevention as well as early diagnosis and treatment is the most important thing for menopausal and perimenopausal women to know.

Treatment and Management of MASLD


While there’s no specific medication approved yet, however, lifestyle modification is highly effective and should be the primary treatment for early stages of MASLD.


Changes in diet are critical and the most studied is the Mediterranean diet which has been shown to be the most effective diet for health and longevity and the prevention of many health conditions such as diabetes, heart disease and Alzheimers. Prioritize vegetables, fruits, whole grains, lean proteins, and healthy fats (like extra virgin olive oil and omega-3s from fish and nuts and seeds). Download my free MED diet checklist here.


Maintain an active daily lifestyle— aim for at least 150 minutes of moderate exercise weekly. For weight loss the movement needs to be at 300 minutes of moderate intensive exercise weekly. And 2-3 of these sessions per week should be resistance training.


Manage metabolic risk factors — control blood sugar, cholesterol, and blood pressure.

Avoid alcohol and processed foods and avoid foods that have added sugars. I also suggest avoiding adding sugar into things like your coffee/tea and limiting the intake of foods that contain high fructose corn syrup (e.g. pop) as well as trans fats and deep fried foods. Even a 5–10% weight loss can significantly reduce liver fat and inflammation.


"Weight loss in postmenopausal women can significantly improve both metabolic and psychological outcomes, helping to prevent MASLD and related conditions." (Milani, et al, 2025)



Proper labs and testing - Based on functional ranges for ALT I like women to be <20 U/L and men to be <25 U/L and I also calculate a FIB-4 score for liver fibrosis (it is a calculation of ALT, AST and blood platelets). The lower the better, but < 1.3 is optimal. I also run a full Liver function panel for my patients that includes not just ALT, but also AST, ALP and fasting insulin and fasting glucose. If indicated, an abdominal ultrasound can also be discussed as a scan that can help with diagnosis.


Menopause is a turning point for liver and metabolic health. The hormonal changes of this period, combined with lifestyle and genetic factors, can raise the risk for developing MASLD and related complications. Supporting women through education, regular screening, and individualized preventive care is key to reducing the burden of MASLD for those in midlife and beyond.


If you would like to book a free discovery call with Dr. Amy click here.


To your best health,


Dr. Amy J. Tung, ND

Naturopathic Doctor | Menopause Society Certified Practitioner


References


Brady CW. Liver disease in menopause. World J Gastroenterol. 2015 Jul 7;21(25):7613-20. doi: 10.3748/wjg.v21.i25.7613. PMID: 26167064; PMCID: PMC4491951.


Milani, I., Chinucci, M., Leonetti, F., & Capoccia, D. (2025). MASLD: Prevalence, Mechanisms, and Sex-Based Therapies in Postmenopausal Women. Biomedicines, 13. https://doi.org/10.3390/biomedicines13040855.


Rinella, M. E., et al. (2023). “A new nomenclature for fatty liver disease: Metabolic dysfunction–associated steatotic liver disease (MASLD).” Journal of Hepatology.


Younossi, Z. M., et al. (2023). “Global epidemiology of MASLD and MASH: Implications for public health.” Hepatology.


American Liver Foundation. (2024). Understanding MASLD (formerly NAFLD). https://liverfoundation.org


World Health Organization. (2024). Noncommunicable diseases and metabolic disorders.



Disclaimer:


The information in this blog is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your doctor or other qualified health professional with any questions regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking treatment because of something you have read in this blog.


Individual results may vary, and the strategies discussed here are not guaranteed to work for everyone. This content does not create a patient-client relationship and should not be used as a replacement for personalized medical care.


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